<!doctype html>
<html>
<head>
	<meta charset=UTF-8 />
	<meta name="referrer" content="no-referrer">
	<meta http-equiv="X-UA-Compatible" content="IE=edge,Chrome=1" />
	<meta name="renderer" content="webkit">
	<meta name="viewport" content="width=device-width, initial-scale=1.0,maximum-scale=1.0">
	<meta name=keywords content="{$keywords}"/>
	<meta name=Description content="{$description}"/>
	<title>{$title}</title>
	<link href="static/layui/css/layui.css" rel="stylesheet">	
	<style>		
	.site-block{padding: 20px; border: 1px solid #eee;}
	.site-block{margin-top: 20px;}
	</style>
</head>
<body>
<div class="layui-container">  
  <div class="layui-row">
    <div class="layui-col-xs12">
	
	<div class="site-text site-block">
      <form class="layui-form" method="post" action="index/index">
        <div class="layui-form-item">
          <label class="layui-form-label">姓名</label>
          <div class="layui-input-block">
            <input type="text" name="name" required="" lay-verify="required" placeholder="请输入姓名" autocomplete="off" class="layui-input">
          </div>
        </div>
        <div class="layui-form-item">
          <label class="layui-form-label">手机</label>
          <div class="layui-input-inline">
            <input type="text" name="phone" required="" lay-verify="required|phone" lay-vertype="tips" placeholder="请输入手机" autocomplete="off" class="layui-input">
          </div>
          <div class="layui-form-mid layui-word-aux">手机</div>
        </div>
        <div class="layui-form-item">
          <label class="layui-form-label">商圈</label>
          <div class="layui-input-block">
            <select name="addr_mark" lay-verify="required">
              <option value=""></option>
              <option value="赛格">赛格</option>
              <option value="华强电子世界">华强电子世界</option>
           </select>
          </div>
        </div>
        <div class="layui-form-item layui-form-text">
          <label class="layui-form-label">备注</label>
          <div class="layui-input-block">
            <textarea name="desc" placeholder="请输入内容" class="layui-textarea"></textarea>
          </div>
        </div>
        <div class="layui-form-item">
          <div class="layui-input-block">
            <button class="layui-btn" lay-submit="">立即提交</button>
            <button type="reset" class="layui-btn layui-btn-primary">重置</button>
          </div>
        </div>
      </form>
    </div>


    </div>
  </div>
</div>




<script src="static/jquery/jquery.js"></script>
<script src="static/layui/layui.js"></script>

<script>
layui.use('form', function(){
	var form = layui.form;

 
});
</script>
<include file="Public:footer"/>
</body></html>